CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: Medstar Health Physical Therapy

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $60
Cash Discount Price: $56
vs. Medicare Baseline: 2.06x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at Medstar Health Physical Therapy is $60. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $56. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.06x the Medicare baseline. Located in 102 Irving St Nw, Washington, DC.

Cash / Self-Pay

$56

Average discount available for prompt cash payment at this facility.

Insurance Median

$60

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$29.06

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $29.06 (100%)

Cash / Self-Pay: $56 (193%)

Insurance Median: $60 (206%)

Cash: $56 (193% of Medicare)

Ins. Median: $60 (206% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $29.06 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 206% of the Medicare baseline (a markup of 106%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Carefirst Advantage Inc	$32	110%
Tricare	$32	110%
UnitedHealthcare	$32 - $239	110%
Aetna	$33 - $64	114%
Health Care Service Corporation	$33	114%
Humana	$33	114%
Kaiser Permanente	$33 - $67	114%
Medstar Family Choice Inc	$37	127%
Carefirst Blue Choice Inc	$39 - $59	134%
Jhhc	$52 - $60	179%
Pfc	$52 - $60	179%
Kaiser	$63 - $72	217%
Cigna	$68 - $78	234%
First Health	$68 - $78	234%
Private Healthcare Systems (Phcs)	$68 - $78	234%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $56.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97110.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Medstar Health Physical Therapy is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97110.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.